News & Politics

Do you see me now?

At 60, she felt invisible--overlooked by salesclerks and waiters. Would a facelift make a difference in the way people treated her? Would it change how she saw herself?

I suppose I should have been flattered. When I told my family, friends, and colleagues that I was thinking about a facelift, they all said I was nuts.

I didn't have wrinkles, crow's feet, frown lines, or droopy eyelids–no mean feat for a 60-year-old. Because I smile a lot and talk even more, my nasolabial creases weren't always noticeable. When my face was still, those creases looked as deep as the Grand Canyon–to me, anyway.

But the people around me apparently didn't see what I saw. Though I tried to keep up appearances with makeup, chemically induced blondness, and a with-it wardrobe, the woman in the mirror mocked my efforts as self-delusion. I saw saggy jowls and multiple chins that no diet seemed to erase. Some days I had a hard time placing the face.

In the past few years, I had begun to feel invisible–ignored by waiters, flight attendants, and salesclerks–even when they were other women. The sentiment that I looked "terrific for a woman my age" offered no comfort. What exactly does that mean?

At my age, my grandmother wore lace-up black shoes and counted her pills.

At my age, my mother spent her weekends on the golf course and counted the months until she could retire to Florida.

At 60, I was writing my first book and working out with a personal trainer. I wanted to see myself and have others see me as a woman with an interesting future as well as an interesting past. My face didn't seem to match me anymore.

So I did what any savvy journalist would do under the circumstances. I got myself assigned to do a story on facelifts.

When I started, my research was mostly academic. But each time I interviewed a cosmetic surgeon, I asked, "If I came to you, what would you do?" Most were very diplomatic, asking me what bothered me about my face. By the time the article was finished, I could hardly look in the mirror without pulling up one cheek to see how I'd look with "a little work."

Wh ile researching the article, published in April 2003, I learned that plastic surgery had changed dramatically in the previous decade. Incisions are smaller and recovery times shorter. Most procedures are done as outpatient surgery.

Age and gravity cause the face to deflate, as both fat and tissue head south. Plump cheeks get hollow, jowls appear, and chins multiply.

Cosmetic surgeons now resculpt the aging face to restore youthful contours rather than just pulling skin tight. Fewer patients emerge with the distorted features and the "caught in a wind tunnel" look that are giveaways of a facelift.

One thing that hasn't changed: Cosmetic surgery is still pricey and not covered by insurance. A traditional facelift, confined to the lower third of the face, costs $8,000 to $10,000. Work on cheeks, eyelids, or the mouth is billed separately, although many surgeons discount additional procedures if done at the same time.

Men are the best candidates for traditional facelifts because they are less likely to get jowls; women usually need work on their cheeks, too.

Last October, I went for an initial consultation with Dr. Steven Hopping. He was one of several cosmetic surgeons I had interviewed over the years, he was on The Washingtonian's list of top doctors, and he had worked on a couple of close friends.

Hopping is both dashing and down-to-earth, with none of the arrogance that makes some doctors so off-putting. He must be in his fifties but doesn't look it.

Hopping took several photographs, looked at my face from every angle, and felt my skin's elasticity and bone structure. I was a good candidate for an S-lift, he said, because I didn't have loose skin on my neck and my skin was pretty elastic. The procedure gets its name from the "S" shape of the incision, which is hidden in the curve in front of the ear. The bottom of the "S" is under the earlobe.

Hopping would raise the underlying tissues vertically and tighten the muscles in my cheeks and lower face. He would inject fat, "harvested" from my abdomen via liposuction, into the nasolabial creases. Hopping also would "liposculpt"–or remove fat from–my chin and tighten the platysma muscle in my neck. The two cords down the middle of the neck are the edges of the muscle. He would suture them together to give my neck a flat, more youthful look. This muscle separates and droops as you age.

While he was at it, Hopping suggested that he could correct my crooked nose. It was broken at birth and has listed left ever since. I never minded much until the appearance of nasolabial creases bracketing my nose and mouth. It was disconcerting to see myself aging asymmetrically.

But a nose job? If you think it's hard to justify a facelift, try explaining a nose job at 60. I was one of the few girls in my Long Island neighborhood who didn't spend spring vacation of our senior year in high school recovering from rhinoplasty.

Growing up, I thought "deviated septum" was a euphemism for "You're not going off to college with that nose." I remember my friends' suffering–their noses painful and packed with cotton for a long, sleepless week after surgery. Did I want to go through that?

Besides, I wanted to look like the old me–and the old me had a left-leaning nose. Would symmetry be too big a change?

Hopping took the photos of my face, both straight-on and profile, and projected them on a computer. With a cursor, he began to "sculpt" the images. We went back and forth on the extent of the changes. I didn't want my nose made thinner, shorter, or the tip "refined" too much.

I agonized for a few weeks, while my family came down on the side of my misaligned nose. My husband, Benjamin, thought I was crazy to undergo any cosmetic surgery.

But he did admit that a facelift was no crazier than buying a sports car–which he did a few years ago. My facelift would cost a lot less and should last a lot longer.

Id ecided to go for it all: S-lift, rhinoplasty, and liposculpture on my neck and chin. I put my name on Hopping's surgical schedule for December 3.

First I needed a physical, including an EKG and a blood count to assess my ability to handle the trauma of surgery. Surgery is always a risk. People with high blood pressure and diabetes, for example, are bad candidates.

On November 18, I went for a pre-surgery consultation. Hopping asked me to bring an old photograph of myself so that he could see my face before it began to age. I brought my wedding engagement photo, taken when I was 25.

Hopping said I wouldn't look 25 again, but the photo would serve as a reference. He took more photos and dictated notes for himself. He pushed at the "buckle fat" in my lower face that would be liposuctioned away along with the pad of fat under my chin.

Buckle fat? The vocabulary of cosmetic surgery can make any anomaly sound like a major flaw. (Buckle fat is part of the jowl.) I recoiled when the tip of my nose was described as "bulbous" but decided to keep that tip anyway. In the conflict between ideal and individuality, individuality won.

Next I met with Sandy, a nurse, to discuss surgical risks and postoperative care. I had already decided to hire one of Hopping's nurses, the aptly named Angel, to come home with me for the first 24 hours.

Sandy told me to expect bruising, swelling, and exhaustion for a few weeks. Taking medications and using ice would help. Some people also experience post-surgery depression.

That day I began the pre-surgery regimen: no aspirin, ibuprofen, or vitamin E for two weeks before surgery because they can inhibit blood clotting. I began taking multivitamins twice a day and vitamin C, which helps the body heal. A week before surgery, I added arnica, an herbal aid to healing.

I stocked up on frozen peas–a plastic bag filled with frozen peas is an ideal ice pack because it molds to the contours of your face.

The day before surgery, I would start a course of antibiotics and a week of steroids, to minimize swelling. I filled two prescriptions–a pain reliever with codeine and Xanax to help me relax.

Sandy told me that patients find Xanax more helpful than a sleeping pill in the first days after surgery. She had gotten an S-lift a year earlier. I admired her jaw line.

Be njamin drove me to Hopping's office at dawn on December 3. The surgery would be performed in Hopping's operating suite with a nurse anesthetist to administer IV sedation. I donned a surgical gown and "shower" cap. Electrodes were placed on my chest to monitor my heart.

Hopping's surgical suite and his staff are certified in emergency procedures. They have a crash cart, a defibrillator, and a plan to transfer patients to George Washington University Hospital, two blocks away, if the need arises.

Hopping doesn't use general anesthesia. I didn't think much about it at the time, but months later novelist Olivia Goldsmith, author of The First Wives Club, died on the operating table before her cosmetic surgery began, the result of a fatal reaction to anesthesia.

Hopping marked my face with a pen while I was sitting up because jowls flatten when the patient is lying down. I remember climbing onto a padded surgical table. I woke up five hours later.

Using a needle, Hopping first suctioned a small amount of fat from my abdomen. This would be stored in a refrigerator, in case I needed to have more fat injected into my nasolabial lines–which could deepen once postsurgical swelling subsided.

Then he did liposuction on my neck and jowls. He sutured the platysma muscle, which would now form a sling to support the neck and improve its contour. All of this was done through an inch-long incision under my chin.

It was time for my S-lift. An anesthetic solution was injected in front of each ear to help separate the skin from the underlying tissue. Then Hopping surgically lifted that tissue–also called the submuscular aponeurotic system or SMAS–and anchored it higher on the cheek. He describes the process as like "pulling a carpet which moves all the furniture on top."

After suctioning out more fat in the lower cheeks, redraping the skin in front of the ears, and snipping away the excess, Hopping closed with sutures under the skin and inside the ears. There would be no visible scars.

The next step–the nose. Hopping started by very conservatively thinning the tip of the nose and smoothing the bump on the bridge. He straightened the septum, but in order to straighten the nose, he had to fracture it and reposition the bones.

Wh en I awoke, bandages circled my head, cupping my neck and covering the incisions in front of my ears. There were plastic splints inside my nostrils and over the top of my nose. A gauze pad was taped under my nose to catch any drippings.

Hello gorgeous!

Angel helped me dress, and Benjamin drove us home. It was about 2 PM. I stayed in bed, my head elevated on pillows, for the first day and night. My face hurt, but it was not as painful as I had feared. It was more of a dull ache than a sharp pain.

The nose was the worst part. Even though there was no cotton packing and I was using decongestant nasal spray, the swelling made breathing through my nose impossible.

Angel checked on me throughout the night, administering cold packs and medications. It was reassuring to have her there.

The next morning Benjamin drove us back to Hopping's downtown office. Angel removed the bandages around my head, washed my hair, and blew it dry. Hopping came in, admired his handiwork, and examined the incisions around my ears, under my chin, and inside my nose. The stitches would dissolve on their own.

He then presented me with a "Hopping headband," a sort of elastic face bra that goes under the chin and closes with Velcro on the top of the head. There were two pouches, one on each side, to be filled with ice packs to ease swelling. I was to wear it 24 hours a day, using the ice packs for 15 minutes every hour. The frozen peas went over my eyes and around my nose.

The swelling and bruising really blossomed the second day. Along with two black eyes, purple bruises formed a Fu Manchu mustache around my nose and mouth. A purple line across my throat looked like someone had tried to garrote me.

I had agreed in advance to let photographer Simon Bruty take my picture after surgery for possible use in this article. As he set up in my living room, he looked a little green every time he focused on me.

That first week, I truly understood what "discomfort" means. It is a persistent unpleasant feeling you can't escape. My face ached, my cheeks were numb, my eyes watered, and my nose itched under the splint. At night, I sometimes panicked about my inability to breathe. I'd turn on late-night TV until the feeling passed. It was hard to keep my eyes on the prize when I couldn't tell how my face would look. The image in the mirror was more Oscar de la Hoya than Oscar de la Renta.

I spent most of my time in bed or on the couch, but I managed to get on the scale a few times. I hadn't been hungry and was on a postsurgery soft diet. I lost five pounds, even though I had eaten a pint of Ben & Jerry's chocolate-chip cookie dough ice cream. Call it the "I can't smell it, taste it, or summon the energy to chew it" diet.

On the eighth day, Hopping removed the splints in and around my nose. My nose had a strong memory, he said. For the first week or two I would have to tape it "straight" at night. For the first several months, I would have to massage it, concentrating on the left side, to keep my nose from creeping back to its old slant. I would also have to massage my chin and neck. Massage helps with lymphatic draining, which reduces swelling. I was still to wear the face bra most of the time for the first two weeks and keep icing.

A makeup person in Hopping's office showed me how to disguise the purple bruises with cosmetics. It took a thick coat of camouflage–I thought I looked more dead than alive. That impression was confirmed when I drove past my office so a colleague could bring down my mail. One look at me and she turned ashen. "I can't believe you're driving," she said diplomatically.

Two weeks after surgery, slathered in makeup, I made a cameo at the office holiday party. The outlines of my new face were beginning to emerge, and the straight nose made a big difference. I was delighted with the response.

Simon Bruty was at the party. "You look a lot better than the last time I saw you," he said.

It was three weeks before I felt presentable enough to go out without heavy makeup or dark glasses and a hat. Regaining my stamina took longer. But any depression I felt was fleeting. Perhaps my aging face bothered me more than I admitted. After a month I was able to go back to the gym.

That didn't mean I was fully healed. For the first six weeks, I felt a hard ridge on my left cheek, the underside of my chin was puffy, and the scar under my chin was visible. Hopping treated the areas with ultrasound and steroid injections. The ridge on my cheek was a hematoma, and the treatment dissolved it. My chin would take longer to heal because it was the site of the most surgery.

The skin in front of my ears and under my chin was numb for three months. As I write this, four months after surgery, the area under my chin is still swollen. I've been told that it will take six months to a year before I see the final result.

Ha s cosmetic surgery changed my life? Yes and no. After a lifetime of sun worship, I'm giving up real rays for fake bronzer. I paid too dearly for this new face to sabotage it in the sun. I'm taking better care of myself in other ways, too. Suddenly, putting in my contact lenses seems worth the effort. It makes more sense to stick to my diet–I'm not going to let this jaw line disappear under a layer of new fat.

Benjamin says I look ten years younger, and he really likes the result. However, cosmetic surgery didn't turn me into a raving beauty. I'm not getting carded, wearing miniskirts, or being mistaken for my daughter's older sister. I haven't stopped the aging clock. Surgery can turn it back, but even before you awaken from anesthesia, that clock starts ticking again.

Most people don't notice enough difference to make them think I've had cosmetic surgery. Since an S-lift doesn't distort facial features, it isn't as obvious as facelifts used to be. When I tell people that I've had "work" done, they think I had an eye lift. Maybe with a smaller face, my eyes look bigger.

Was it worth it? Absolutely. I feel that I've found something that I thought was lost. When I look in the mirror, the face that I see is me.

Two days after surgery, Leslie–in her "face bra"–couldn't smile for the camera.

Information You Can Trust

I found the most up-to-date information about cosmetic surgery on the Internet. These Web sites are particularly good at explaining surgical procedures:

· Run by the American Society of Plastic Surgeons, this site features physician referrals, before and after photos, and a look at costs.

· The American Academy of Cosmetic Surgeons' site spells out what to expect before and after surgery. There's a physician finder, too.

· The American Academy of Facial Plastic and Reconstructive Surgery's site explains any operation of the face, and can help find a surgeon.

· Links to research from well-respected sources such as the Mayo Foundation and medical journals.


Top Cosmetic Surgeons

These physicians, rated best for plastic surgery in a survey of their peers, specialize in adult cosmetic procedures such as facelift and liposuction. Some also do reconstructive surgery, but we've listed just elective procedures.

The information about a physician's specialties and number of years in practice came from the doctor's office.

Some surgeons do cosmetic procedures in an in-office surgical suite, while others use hospital facilities. We've listed where each surgeon has hospital privileges.

Haven J. Barlow Jr., 8501 Arlington Blvd. #420, Fairfax; 703-560-8844. Specializes in cosmetic surgery of the breast and eyelids (blepharoplasty), and liposuction. In practice 12 years. Office surgical suite. FRFX, ALEX, VHC.

Barry J. Cohen, 5530 Wisconsin Ave. #1248, Chevy Chase, 301-656-6398; and 6845 Elm St. #300, McLean, 703-442-4919. Specializes in breast augmentation, liposuction, and nose surgery (rhinoplasty). In practice 12 years. SUB, SG, SIB, MONT, LAU, FRFX, FOAKS, RES, VHC, HC.

Diane L. Colgan, 9800 Falls Rd. #105, Potomac; 301-299-6644. Specializes in facelift, blepharoplasty, breast augmentation, liposuction, and rhinoplasty. In practice 20 years. SUB, SIB, MONT, WHC.

Gregory O. Dick, 9711 Medical Center Dr. #100, Rockville; 301-251-2600. Specializes in blepharoplasty, breast reduction and augmentation, and liposuction. In practice 12 years. Office surgical suite. SUB, MONT, SG.

Craig R. Dufresne, 5530 Wisconsin Ave. #1235, Chevy Chase, 301-654-9151; and 8501 Arlington Blvd. #420, Fairfax, 703-207-3065. Facial rejuvenation (eyelids, face, nose), liposuction, breast augmentation and reduction. In practice 19 years, with concentration on cosmetic work in the past 10. FRFX, JH, SIB.

John S. Eng, 11404 Old Georgetown Rd. #206, Rockville; 301-468-5991. Does mostly double-eyelid surgery for Asians, breast augmentation, Botox, abdominoplasty, and facial surgery–including eyelids and mid-cheek lifts. In practice 30 years, with a concentration on cosmetic work in last half-dozen years. Office surgical suite. HC, SUB.

Albert F. Fleury, Jr., 5550 Friendship Blvd. #130, Chevy Chase, 301-652-7700; and 3299 Woodburn Rd. #490, Annandale, 703-560-2850. Specializes in facelift and liposuction. In practice 23 years. Office surgical suite. FRFX, SIB.

James H. French, 3299 Woodburn Rd. #490, Annandale, 703-560-2850; and 5550 Friendship Blvd. #130, Chevy Chase, 301-652-7700. Specializes in breast augmentation and reduction, facial surgery, and abdominoplasty. In practice 23 years. Office surgical suite. FOAKS, FRFX, SIB.

Roger J. Friedman, 11210 Old Georgetown Rd., North Bethesda; 301-881-7770. Specializes in breast augmentation and reduction, facial plastic surgery, and liposuction. In practice 18 years. Office surgical suite. SG, SUB, GU, SIB, GWU.

Roberta L. Gartside, 1800 Town Center Dr. #412, Reston, 703-742-8004; and 3299 Woodburn Rd., Annandale, 703-204-2706. Specializes in abdominoplasty, liposuction, breast augmentation, and blepharoplasty. In practice 16 years. FRFX, RES.

Macy G. Hall Jr., 1140 Varnum St. #103, NE; 202-723-8768. Mostly breast augmentation and reduction, and abdominoplasty. In practice 36 years. Office surgical suite. FTW, CNMC, PROV, NRH, SUB, WHC.

Steven B. Hopping, 2440 M St., NW #205; 202-785-3175. Specialty in facial surgery–facelift, blepharoplasty, rhinoplasty, chin implants, and liposuction. In practice 23 years. Office surgical suite. GWU, PROV, SIB, WHC.

Lance G. Leithauser, 9715 Medical Center Dr. #535, Rockville; 301-294-9400. Specializes in blepharoplasty, facelift, breast augmentation, rhinoplasty, and liposuction. In practice 26 years. Office surgical suite. SG.

J. William Little, 1145 19th St., NW #802; 202-467-6700. Known for facial rejuvenation–facelift, rhinoplasty, structural fat grafting, and blepharoplasty. In practice more than 25 years. GU, GWU.

Steven D. Macht, 2021 K St., NW #217; 202-887-8120. Facelift, rhinoplasty, liposuction, blepharoplasty, and breast augmentation. In practice 30 years. Office surgical suite. CNMC, GWU, SIB, SUB.

Csaba L. Magassy, 1300 Chain Bridge Rd., McLean; 703-790-5454. Specializes in facelift, rhinoplasty, blepharoplasty, breast augmentation and reduction, and liposuction. In practice 33 years. Office surgical suite. GU, FRFX, SIB, SUB, WHC.

Khosrow Matini, 7910 Andrus Rd. #5, Alexandria; 703-360-9195. Specializes in breast reduction and augmentation, facelift, rhinoplasty, and abdominoplasty. In practice more than 27 years. MV.

Talal A. Munasifi, 1635 N. George Mason Dr. #380, Arlington; 703-841-0399. Primarily does facelifts. In practice 20 years. Office surgical suite. VHC, RES.

Anne M. Nickodem, 3299 Woodburn Rd. #340, Annandale; 5530 Wisconsin Ave. #1135, Chevy Chase; and 1800 Town Center Dr. #412, Reston; 703-560-8711 for all offices. Specializes in abdominoplasty and breast augmentation. In practice 12 years. FRFX, FOAKS, SIB, SUB, RES.

Roger J. Oldham, 10215 Fernwood Rd. #412, Bethesda, 301-530-6100; 19211 Montgomery Village Ave. #B-21, Montgomery Village, 301-977-8280; and 10801 Lockwood Dr. #325, Silver Spring, 301-681-1233. Mostly rhinoplasty, facelift, abdominoplasty, liposuction. and breast augmentation. In practice 25 years. Office surgical suite. HC, SG, SUB, SIB.

Michael Olding, 2150 Pennsylvania Ave., NW; 202-741-3240. Specializes in facial cosmetic surgery and liposuction. In practice 18 years. Office surgical suite. GWU, CNMC, SIB.

Susan E. Otero, 1145 19th St., NW #717; 202-785-4178. Specializes in breast augmentation and abdominoplasty. In practice 17 years. PROV, SIB, WHC, WADV.

Jeffrey C. Posnick, 5530 Wisconsin Ave. #1250, Chevy Chase; 301-986-9475. Specializes in facial surgery–blepharoplasty, rhinoplasty, chin surgery, browlift, and facelift. In practice 17 years. WHC, SUB, FRFX, GU, GWU, SIB, SG.

G. Wesley Price, 5550 Friendship Blvd. #130, Chevy Chase, 301-652-7700; and 3299 Woodburn Rd. #490, Annandale, 703-560-2850. Specializes in breast augmentation and reduction. Also facelifts, liposuction, and abdominoplasty. In practice 19 years. Office surgical suite. FRFX, SIB.

Jorge H. Reisin, 5530 Wisconsin Ave. #1440, Chevy Chase, 301-986-9411; and 9707 Medical Center Dr. #100, Rockville, 301-762-9222. Specializes in facial surgery, liposuction, and breast augmentation and reduction. In practice 32 years. SUB.

Franklin D. Richards, 10215 Fernwood Rd. #280, Bethesda, 301-493-4334; and 1515 Chain Bridge Rd. #310, McLean, 703-506-0683. Specializes in facelift, breast augmentation, liposuction, and blepharoplasty. In practice 15 years. Office surgical suite. FRFX, SUB SG.

Mark E. Richards, 11300 Rockville Pike #912, North Bethesda; 301-468-3458. Specializes in facial rejuvenation–endoscopic brow lift, mid-face cheek lift, face and neck lift, and blepharoplasty. In practice 14 years. SUB, SIB, HC.

Thomas J. Sanzaro, 4530 Connecticut Ave., NW #112, 202-686-6270; and 3301 New Mexico Ave., NW #206, 202-895-1440. Mostly facial surgery, breast augmentation, rhinoplasty, and liposuction. In practice 24 years. SIB.

Carol S. Shapiro, 1940 Opitz Blvd., Woodbridge, 703-494-1163; and 9001 Digges Rd. #205, Manassas, 703-361-2628. Specializes in facelift, breast augmentation and reduction, and liposuction. In practice 32 years. POT, ALEX, FOAKS, LOU, PW, MV.

Scott L. Spear, 3800 Reservoir Rd., NW; 202-444-2000. Breast augmentation, body contouring and liposuction–particularly of the hips and thighs–rhinoplasty, and facelift. In practice 24 years. Office surgical suite. GU, SIB.

Michael P. Vincent, 9715 Medical Center Dr. #315, Rockville; 301-738-9137. Specializes in liposuction, facelift, blepharoplasty, abdominoplasty, and breast augmentation and reconstruction. In practice 20 years. Office surgical suite. SG, SUB, HC, MONT.

Here is a guide to hospital abbreviations:

ALEX (Inova Alexandria Hospital); CNMC (Children's National Medical Center); FOAKS (Inova Fair Oaks Hospital); FRFX (Inova Fairfax Hospital); FTW (Fort Washington Hospital); GU (Georgetown University Medical Center); GWU (George Washington University Hospital); HC (Holy Cross Hospital); JH (Johns Hopkins Hospital); LAU (Laurel Regional Hospital); LOU (Loudoun Hospital Center); MONT (Montgomery General Hospital); MV (Inova Mount Vernon Hospital); NRH (National Rehabilitation Hospital); POT (Potomac Hospital); PROV (Providence Hospital); PW (Prince William Hospital); RES (Reston Hospital Center); SG (Shady Grove Adventist Hospital); SIB (Sibley Memorial Hospital); SUB (Suburban Hospital); VHC (Virginia Hospital Center); WADV (Washington Adventist Hospital); WHC (Washington Hospital Center).